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DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Western Pennsylvania Area. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) plan features an annual prescription drug deductible of $615. Under this plan, Tier 6 select care drugs have no copay for standard pharmacy and mail-order fills. For other generics, standard pharmacy and mail-order options charge an $18 copay for Tier 1 preferred generics and a $20 copay for Tier 2 generics for a 1-month supply. Higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require 23% coinsurance, while Tier 4 non-preferred drugs have a 26% coinsurance. Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply through standard retail or mail-order services.
Additional Benefits
The DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and covered preventive care. For specialist visits, outpatient services, and emergency care, members will encounter predictable copays, such as $35 to $50 for specialists and $115 for emergency room visits with no coinsurance. Inpatient hospital stays require a daily copay of $320 for the first few days, after which there is no copay for the remainder of the stay. This plan also features robust supplemental benefits, including dental coverage up to a $2,000 annual limit and eyewear up to a $300 annual limit with no copay or coinsurance. Routine hearing exams are available for a $35 copay, while prescription hearing aids require copays between $399 and $699. Additionally, members receive an allowance of up to $50 every three months for over-the-counter items with no copay, while durable medical equipment is covered with a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) with no coinsurance, requiring a daily copay of $320 for days 1-6 of acute stays (no copay for days 7-90) and $320 for days 1-5 of psychiatric stays (no copay for days 6-90). This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $420 copay and observation services with a $320 copay per stay. Outpatient substance abuse sessions require a $35 copay, while ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers ground ambulance services with a copay ranging from no copay to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, while transportation services are not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay to a $40 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $25,000 maximum benefit with a $115 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and podiatry services require copays ranging from $35 to $50 and no coinsurance. For chiropractic care, some services are covered but routine and other chiropractic services are not covered. Telehealth and other health professional services are also available with copays up to $40 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and kidney disease education. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP), offering routine hearing exams for a $35 copay and no coinsurance, and up to two prescription hearing aids per year with a copay between $399 and $699 and no coinsurance. Fitting evaluations are covered, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP), offering one routine eye exam per year with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $300 annual maximum benefit for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP), featuring a $2,000 annual maximum with no copay and no coinsurance for covered preventive and comprehensive services. While Medicare-covered dental services require a $35 copay and no coinsurance, some services like orthodontics, implants, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment and ranging from no coinsurance to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay and up to 20% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) with prior authorization required. Diagnostic services carry no coinsurance, offering lab services with no copay and diagnostic tests with a $0 to $95 copay, while radiological services feature no copay for X-rays and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) with no coinsurance and require prior authorization, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior 3-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP) offers partially covered other services, providing over-the-counter (OTC) items (up to $50 every three months), non-Medicare covered diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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